DR. HIRAMALINI SESHADRI

Jaundice occurs during the course of many diseases. Look for the actual cause.

ARUN thought he had viral hepatitis because he was jaundiced. But he had malaria. Shanthi went to the doc thinking the same but she had Dengue fever. Ramu with similar complaints ended up with a diagnosis of leptospirosis. That's the point; jaundice can be a symptom of many diseases.Jaundice, or yellow pigmentation of the schlera (the white of the eye) and the skin in general, occurs when the level of bilirubin in the blood increases. In a normal person, the reading is about one milligram in the usual blood tests. Bilirubin is produced when old red blood cells are broken down. The liver excretes it in a water-soluble form into the bile. Part of it goes out with the stools; while some part comes out in the urine. So if the breakdown of red cells increases, the bilirubin levels go up giving you that jaundiced look. This happens in many congenital haemolytic anaemias. The factory that breaks down old or abnormal red cells is the spleen. In haemolytic anaemias, where the red cells are abnormal, the spleen ends up working overtime and becomes enlarged. In fact anaemia and jaundice occurring together with splenic enlargement usually alerts one to the possibility of a haemolytic anaemia. But the same occurs in chronic malaria too, making medicine much like a detective's mission.When some bug affects the liver cells themselves, they are unable to process and excrete the bilirubin fast enough and the person ends up with jaundice. The basic reason for jaundice is all the increasing types of viral hepatitis. Earlier we knew only of hepatitis A and B; today there is hepatitis C, D, E,... and probably more that are awaiting discovery ! Dengue fever, leptospirosis, cytomegalovirus too cause jaundice like this.Sometimes the little channels through which the bilirubin-laden bile has to pass get blocked. So all the bilirubin regurgitates back into the blood. The person is deeply jaundiced; but since the pigment doesn't reach the gut, the stools are a pale clay-white colour; and the pigment in the skin causes severe itching. This is called Obstructive jaundice. Gallstones and TB in the liver can cause this; also tumours. An ultrasound helps pinpoint the cause.Strangely one of the most deadly liver diseases, alcoholic cirrhosis, generally comes on without any jaundice. The patient is often caught napping and then it is too late. Though jaundice is the commonest symptom of liver disease, devastating liver problems can come on sans jaundice.How does one treat jaundice? Obviously treatment is based on what caused it; and therefore there is no single uniform all-jaundice cure. The liver is the biggest storehouse of glycogen, which yields glucose readily for any activity. As this energy generating system is likely to be a little down in liver disease, rest is important. Further, when the liver is down drugs tend to cause more side effects. So use minimum medication and go all out on simple pro-health measures such as rest, glucose and dietary supplementation.The writer is a Senior Consultant, Holistic Internal Medicine and Rheumatology, in Chennai. E-mail her at hiramalini@yahoo.com